Intestinal Malrotation With Pericecal Hernia Causing a Small Bowel Obstruction: A Case Report

Congenital intestinal malrotation is an uncommon developmental anomaly that rarely presents in adulthood. Its coexistence with a pericecal internal hernia and acute midgut volvulus is exceptionally rare, making preoperative diagnosis challenging. We report the case of a 57-year-old man who presented with severe abdominal pain, progressive abdominal distension, vomiting, and obstipation, accompanied by hypovolemic shock. Laboratory investigations revealed leukocytosis, metabolic acidosis, and elevated serum lactate levels. Contrast-enhanced computed tomography demonstrated distal small bowel obstruction with bowel wall thickening and free intraperitoneal fluid, suggestive of strangulation. Emergency exploratory laparotomy revealed congenital intestinal malrotation with the duodenojejunal junction on the right side, an incarcerated pericecal internal hernia, and acute clockwise midgut volvulus with gangrene involving the distal ileum and cecum. The patient underwent hernia reduction, counterclockwise detorsion, resection of the gangrenous bowel, primary ileo-ascending colon anastomosis, and bowel repositioning according to the principles of the Ladd procedure. The patient's postoperative recovery was uneventful. This case highlights the importance of maintaining a high index of suspicion for congenital gastrointestinal anomalies in adults presenting with acute intestinal obstruction. It emphasizes that prompt diagnosis and timely surgical intervention are essential to prevent bowel loss and improve outcomes.